Provider Demographics
NPI:1417155672
Name:KOUL, DEEPAK (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:KOUL
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 GRAHAM RD STE C-2310
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8023
Mailing Address - Country:US
Mailing Address - Phone:314-953-6300
Mailing Address - Fax:
Practice Address - Street 1:1225 GRAHAM RD STE C-2310
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8023
Practice Address - Country:US
Practice Address - Phone:314-953-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010015943207RC0000X, 207RI0011X
IL036126770207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology